Provider Demographics
NPI:1407899008
Name:HULETT-JOHNSON, LESLEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:
Last Name:HULETT-JOHNSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2344
Mailing Address - Country:US
Mailing Address - Phone:407-846-0023
Mailing Address - Fax:407-483-1064
Practice Address - Street 1:1806 TOWN PLAZA CT
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6206
Practice Address - Country:US
Practice Address - Phone:407-234-0670
Practice Address - Fax:407-695-3674
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74399AOtherBCBS
FL7678851Medicaid
FL74399AOtherBCBS